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The manipulation of follicular waves through hormonal treatments, such as estrogen administration, plays a crucial role in optimizing in-vivo oocyte collection for assisted reproductive technologies. The present study aimed to evaluate the effect of two specific types of estrogen on follicular wave dynamics and their impact on in-vivo oocyte collection in Brown Swiss cows. Fourteen cows, in their first lactation, weighing approximately 340 kg were randomly assigned to one of two treatments including T1 (estradiol cypionate) and T2 (estradiol benzoate). Both treatments were administered at 1.2 mg of estrogen, at day 0 of the experiment. All Brown Swiss cows were provided with a diet entirely consisting of alfalfa grazing. On day 7, follicular wave dynamics were assessed using a DP-50 vet ultrasound device equipped with a 7.5 MHz transducer for transvaginal follicular aspiration guidance. Follicle counts were categorized into three size ranges including 2-4 mm (small), 4-8 mm (medium), and greater than 8 mm (large). Additionally, the quantity and quality (viable oocytes) of the collected oocytes were evaluated by the Ovum Pick Up (OPU) team for oocyte viability on day 7. The study assessed the follicular dynamics (number of follicles) and efficiency of oocyte collection (viable oocytes) in cows treated with Estradiol Cypionate (T1) and Estradiol Benzoate (T2). The average number of small, medium-sized, and large follicles size were 6.048 ± 6.037, 3.16 ± 2.01, and 0.53 ± 0.67 respectively. The total number of follicles was 9.59 ± 3.56. The mean number of viable oocytes recovered was 3.024 ± 1.66, while the mean number of non-viable oocytes was 1.47 ± 1.01. The results indicated no significant differences between treatments in the size of small, medium, and large follicles, nor in the total number of follicles and viable oocytes recovered. However, a significant difference was observed in the number of non-viable oocytes recovered, with a higher mean in T2 (1.86) compared to T1 (1.09). The results indicated an adequate follicular response and viable oocyte recovery in both treatment groups (estradiol cypionate and estradiol benzoate). However, variations in oocyte viability were observed, with estradiol cypionate showing a slight advantage. [ABSTRACT FROM AUTHOR]

This retrospective cross-sectional study investigates determinants on follicular development, oocyte retrieval and pregnancy outcome. It assessed the clinical practicability of monitoring parameters in relation to predict a successful treatment. Analysis of serum-estradiol (E2), sonographic follicle count, number of oocytes and optimizable parameters have therefore been carried out based on patient files from the IVF outpatient clinic at the Department of Gynecology, Obstetrics and Reproductive Medicine, Homburg/Saar, Germany. Equidirectional connection occurred between serum-E2, sonographic follicle count and number of oocytes (p < 0.001). There was no significant difference between sonographic and punctured follicle count (p = 0.428), but between sonographic/punctured follicle count and number of oocytes obtained (p < 0.01). Increasing endometrial thickness was associated with increasing serum-E2 (p = 0.003) and number of oocytes (p < 0.001), but not with the follicle count (p > 0.05). Additionally, age was inversely associated with sonographic follicle count and number of oocytes (p < 0.001) but not with E2 (p > 0.05). BMI, nicotine and stimulation protocol had no association with the observed parameters (p > 0.05). Mean differences in follicle numbers can be used for predicting expectable numbers of oocytes. Due to comparable numbers of follicles visualized on the day of ovulation induction and the number of follicles punctured, more emphasis should be placed in optimizing oocyte retrieval procedures.

This retrospective cross-sectional study investigates determinants on follicular development, oocyte retrieval and pregnancy outcome. It assessed the clinical practicability of monitoring parameters in relation to predict a successful treatment. Analysis of serum-estradiol (E2), sonographic follicle count, number of oocytes and optimizable parameters have therefore been carried out based on patient files from the IVF outpatient clinic at the Department of Gynecology, Obstetrics and Reproductive Medicine, Homburg/Saar, Germany. Equidirectional connection occurred between serum-E2, sonographic follicle count and number of oocytes (p < 0.001). There was no significant difference between sonographic and punctured follicle count (p = 0.428), but between sonographic/punctured follicle count and number of oocytes obtained (p < 0.01). Increasing endometrial thickness was associated with increasing serum-E2 (p = 0.003) and number of oocytes (p < 0.001), but not with the follicle count (p > 0.05). Additionally, age was inversely associated with sonographic follicle count and number of oocytes (p < 0.001) but not with E2 (p > 0.05). BMI, nicotine and stimulation protocol had no association with the observed parameters (p > 0.05). Mean differences in follicle numbers can be used for predicting expectable numbers of oocytes. Due to comparable numbers of follicles visualized on the day of ovulation induction and the number of follicles punctured, more emphasis should be placed in optimizing oocyte retrieval procedures. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate live birth rates (LBRs) for in vitro fertilization (IVF) cycles with ≤5 follicles at trigger, with the goal of helping patients with low follicle counts decide whether to proceed to retrieval. Methods: This is a retrospective cohort study from an urban, university-affiliated fertility center. All IVF cycles that yielded <10 oocytes between 2016 and 2020 were reviewed. Cycles were included if <5 follicles measuring >14 mm were verified on trigger day. The primary outcome was LBR per retrieval after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes, 2-pronuclear zygotes (2-PNs), blastocysts for transfer/biopsy, and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT-A) was used). Results: 1502 cycles (900 with PGT-A) from 972 patients were included. Mean number of oocytes, mature oocytes, 2-PNs, blastocysts for transfer/biopsy, and euploid blastocysts differed by follicle number (p < 0.001). Across all age groups, there were differences in LBR associated with follicle number (p < 0.001). However, within age groups, not all results were significant. For example, for patients <35 years, LBR did not differ by follicle number and among patients 35–37 years; LBR with two or three follicles was lower than with five (p < 0.02). LBR for patients 35–40 years was <20% with 1–3 follicles and 25–40% with 4–5 follicles. LBR for patients >41 years was <5% with 1–3 follicles and <15% with 4–5 follicles. Conclusion: As expected, LBR is higher with more follicles. Providing patients with <5 follicles with specific data can help them weigh the emotional, physical, and financial costs of retrieval. [ABSTRACT FROM AUTHOR]

Abstract Background Nutrition has not only an impact on the general wellbeing of an animal but can also affect reproductive processes. In cattle, feeding regimes can influence the age of puberty onset and alter gonadal development. We analyzed effects of different milk replacer (MR) feeding regimes during rearing on ovarian physiology with specific emphasis on the numbers as well as gene expression characteristics of granulosa cells (GCs) at the age of puberty onset. Two groups of calves received either 10% or 20% of bodyweight MR per day during their first 8 weeks. After weaning, both groups were fed the same mixed ration ad libitum until slaughter at 8 months. Results Animals of the 20% feeding group had a significantly higher body weight, but the proportion of animals having a corpus luteum at the time of slaughter was not different between groups, suggesting a similar onset of puberty. Calves of the 10% group showed a constant GC count regardless of the number of follicles (r = 0.23) whereas in the 20% group increasing numbers of GCs were detected with a higher follicle count (r = 0.71). As a first effort to find a possible molecular explanation for this unexpected limitation of GC numbers in the 10% group, we comparatively analyzed GC transcriptomes in both diet groups. The mRNA microarray analysis revealed a total of 557 differentially expressed genes comparing both groups (fold change > |1.5| and p

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Background: Nutrition has not only an impact on the general wellbeing of an animal but can also affect reproductive processes. In cattle, feeding regimes can influence the age of puberty onset and alter gonadal development. We analyzed effects of different milk replacer (MR) feeding regimes during rearing on ovarian physiology with specific emphasis on the numbers as well as gene expression characteristics of granulosa cells (GCs) at the age of puberty onset. Two groups of calves received either 10% or 20% of bodyweight MR per day during their first 8 weeks. After weaning, both groups were fed the same mixed ration ad libitum until slaughter at 8 months. Results: Animals of the 20% feeding group had a significantly higher body weight, but the proportion of animals having a corpus luteum at the time of slaughter was not different between groups, suggesting a similar onset of puberty. Calves of the 10% group showed a constant GC count regardless of the number of follicles (r = 0.23) whereas in the 20% group increasing numbers of GCs were detected with a higher follicle count (r = 0.71). As a first effort to find a possible molecular explanation for this unexpected limitation of GC numbers in the 10% group, we comparatively analyzed GC transcriptomes in both diet groups. The mRNA microarray analysis revealed a total of 557 differentially expressed genes comparing both groups (fold change > |1.5| and p < 0.05). OAS1X, MX2 and OAS1Z were among the top downregulated genes in the 20% vs. the 10% group, whereas top upregulated genes comprised BOLA and XCL1. All of these genes are known to be regulated by interferon. Subsequent signaling pathway analysis revealed the involvement of several immune response mechanisms in accordance with a number of interferons as upstream regulators. Conclusions: The results indicate that the plane of MR feeding in early life has an impact on the number and physiology of GCs later in life. This might influence the overall reproductive life initiated by the onset of puberty in cattle. In addition, the observed alterations in GCs of calves fed less MR might be a consequence of interferon regulated immunological pathways. [ABSTRACT FROM AUTHOR]

Abstract Background Polycystic ovary syndrome (PCOS) is diagnosed based on chronic anovulation, androgen excess (clinical and/or biochemical), and polycystic ovaries in ultrasound. The aim of the present study was to evaluate which parameters in the transvaginal ultrasound (TVUS) of ovaries could be better associated with concurrent hormonal imbalance in the women with PCOS. Methods Using a cross-sectional design, this study focused on 61 subjects (18–40 years) with PCOS. Patients were recruited at three academic hospitals during the 2017–2019 period. PCOS was defined according to the Rotterdam criteria. The association of ovarian morphology with hormonal and metabolic feature was investigated using linear regression models, adjusted for a set of possible confounding variables including age, mensuration status and body mass index (BMI). Results The mean volume of both ovaries was positively associated with the total testosterone level (β = 0.025, P value

Objective: To investigate the diagnostic performance of high-resolution single-shot fast spin-echo (SSFSE) imaging with deep learning (DL) reconstruction algorithm on follicle counting and compare it with original SSFSE images and conventional fast spin-echo (FSE) images. Methods: This study included 20 participants (40 ovaries) with clinically confirmed polycystic ovary syndrome (PCOS) who underwent high-resolution ovary MRI, including three-plane T2-weighted FSE sequences and slice-matched T2-weighted SSFSE sequences. A DL reconstruction algorithm was applied to the SSFSE sequences to generate SSFSE-DL images, and the original SSFSE images were also saved. Subjective evaluations such as the blurring artifacts, subjective noise, and clarity of the follicles on the SSFSE-DL, SSFSE, and conventional FSE images were independently conducted by two observers. Intra-class correlation coefficients and Bland–Altman plots were used to present the repeatability and reproducibility of the follicle number per ovary (FNPO) based on the three types of images. Results: SSFSE-DL images showed less blurring artifact, subjective noise, and better clarity of the follicles than SSFSE and FSE (p < 0.05). For the repeatability of the FNPO, SSFSE-DL showed the highest intra-observer (ICC = 0.930; 95% CI: 0.878–0.962) and inter-observer (ICC = 0.914; 95% CI: 0.843–0.953) agreements. The inter-observer 95% limits of agreement (LOA) for SSFSE-DL, SSFSE, and FSE ranged from −3.7 to 4.5, −4.4 to 7.0, and −7.1 to 7.6, respectively. The intra-observer 95% LOA for SSFSE-DL, SSFSE, and FSE ranged from −3.5 to 4.0, −5.1 to 6.1, and −5.7 to 4.2, respectively. The absolute values of intra-observer and inter-observer differences for SSFSE-DL were significantly lower than those for SSFSE and FSE (p < 0.05). Conclusions: Compared with the original SSFSE images and the conventional FSE images, high-resolution SSFSE images with DL reconstruction algorithm can better display follicles, thus improving FNPO assessment. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is diagnosed based on chronic anovulation, androgen excess (clinical and/or biochemical), and polycystic ovaries in ultrasound. The aim of the present study was to evaluate which parameters in the transvaginal ultrasound (TVUS) of ovaries could be better associated with concurrent hormonal imbalance in the women with PCOS. Methods: Using a cross-sectional design, this study focused on 61 subjects (18–40 years) with PCOS. Patients were recruited at three academic hospitals during the 2017–2019 period. PCOS was defined according to the Rotterdam criteria. The association of ovarian morphology with hormonal and metabolic feature was investigated using linear regression models, adjusted for a set of possible confounding variables including age, mensuration status and body mass index (BMI). Results: The mean volume of both ovaries was positively associated with the total testosterone level (β = 0.025, P value < 0.001), free androgen index (β = 0.041, P value < 0.001) and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio (β = 0.032, P value = 0.004), even after adjustments made for age, mensuration status and BMI (fully-adjusted model). In contrast, in the fully-adjusted model, antral follicle count (AFC), follicle number per ovary (FNPO), ovarian area, stromal area, and ratio of stromal area to ovarian area (S/A) were not associated with androgen levels and LH/FSH ratio. In addition, after full adjustments, ovarian volume, AFC, FNPO, ovarian area, stromal area and S/A were not associated with insulin resistance, which was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR). Conclusion: Increased ovarian volume is, thus, highly predictive of hyperandrogenemia and high LH/FSH ratio in PCOS patients. [ABSTRACT FROM AUTHOR]

Some synthetic polymers can be used at low concentrations to reduce the toxicity of conventional cryoprotectant agents. In this study we investigated whether the addition of synthetic polymers to a conventional cryoprotectant solution would improve the cryopreservation of bovine ovarian tissue. Freshly collected ovaries from ten adult crossbred cows were incised using a scalpel in the frontal section. From each cow, ovarian cortical slices of 1 mm thickness were divided into 30 fragments of 3 × 3 mm, of which 10 served as fresh controls, 10 were vitrified with conventional cryoprotectant agents (2.93 M glycerol, 27 % w/v; 4.35 M ethylene glycol, 27 % w/v), and 10 were vitrified using the same cryoprotectant agents in addition to synthetic polymers (0.2 % PVP K-12, 0.2 % SuperCool X-1000 ™ w/v and 0.4 % SuperCool Z-1000 ™ w/v). After warming, histology was used to assess follicular quantity and integrity, while in vitro culture of mechanically isolated follicles encapsulated in an alginate matrix was performed for 15 days to assess their growth and hormonal production. Vitrified ovarian tissues presented abnormal morphology, a higher percentage of atretic follicles, and their isolated follicles had lower survival rates and lower frequency of antrum formation during in vitro culture compared to those from fresh tissue. At the end of culture, the follicles that had been cryopreserved produced less estradiol and progesterone than the fresh ones. The addition of synthetic polymers during tissue vitrification did not modify any of these parameters. We conclude that, under the conditions of this study, the use of this combination of synthetic polymers for tissue vitrification did not enhance the preservation of the morphological or functional integrity of bovine ovarian follicles. [ABSTRACT FROM AUTHOR]

Context: Anti-Müllerian hormone (AMH) levels strongly correlate with the number of antral follicles (total follicle count, TFC) in the ovary. In women with polycystic ovary syndrome (PCOS), this is reflected by significantly increased serum AMH levels. Different assays have been developed to measure AMH. However, little is known about the interassay correlation in women with increased AMH levels. Objective: To investigate the correlation of AMH values between different AMH assays and with TFC in PCOS patients. Methods: AMH levels were measured in 1660 PCOS patients, using 3 different AMH assays: Gen II (Beckman Coulter); picoAMH (Ansh Labs); and Elecsys (Roche). Passing Bablok regression was used to compare assay methods. Spearman’s correlation was used to correlate AMH levels and TFC. Results: Strong interassay correlations were present over the total range of AMH levels (0.81-0.94). Stratification in subgroups, revealed an AMH level–dependent interassay correlation with strong interassay correlations in the low (<2.80 ng/mL) and high (>7.04 ng/mL) subgroups (0.62-0.86). However, the correlation in the mid-AMH subgroup (2.80-7.04 ng/mL) was only moderate (0.28-0.56). A strong correlation was present between the total range of AMH levels and TFC (0.57-0.62). However, in all 3 AMH subgroups the correlation became moderate at best, independently of assay method (0.11-0.45). Conclusion: In conclusion, both the interassay correlation and the correlation between AMH level and follicle count depend on the range of serum AMH levels. This once more emphasizes the need of a standardization of AMH measurement for an accurate interpretation of AMH in clinical practice. [ABSTRACT FROM AUTHOR]

Electromagnetic waves (EMF) are a mixture of electrical and magnetic waves. The energy transmitted by these radiations is absorbed by living tissues. Electromagnetic fields seem to cause infertility in women. Cannabis is annual herbaceous plant grows in tropical areas. This study was conducted to investigate the protective effects of hydroalcoholic extract of Cannabis sativa in various doses of 50, 100 and 150 mg / kg on the damages induced by electromagnetic fields of 50 Hz and 50 Gauss, on the puberty of ovarian follicles and levels of FSH, LH, estradiol and progesterone hormones in NMRI immature mice. In this study, 48 NMRI immature female mice with an approximate age of 16 days and approximate weight of 18 grams were divided into 8 (experimental, sham, positive control and negative control) groups. After the treatment, the ovaries were extracted and weighed, and sections with H& E staining, the number of primordial, primary, secondary, and atretic follicles were counted, and the level of hormones have been done. The results showed that the concentration of 50 mg / kg of cannabis extract after the exposure to electromagnetic field of 50 Gauss could increase the number of follicles and reduce the number of atresia follicles. The group treated with the concentration of 50 mg / kg of cannabis extract after the exposure to electromagnetic field of 50 Gauss showed increased levels of FSH, LH and estradiol hormones (p

Purpose: The aim of this study was to determine the relationship between polycystic ovarian morphology (PCOM), ovarian morphology, anti-Müllerian hormone (AMH), and testosterone levels in young nulliparous Korean women. Materials and Methods: A total of 139 PCOM patients were evaluated from 2013 to 2018. The relationships between serum AMH levels and androgenic hormones, clinical signs of polycystic ovarian syndrome (PCOS), and ovarian morphology were investigated. Results: Irregular menstruation was the most common symptom in women with PCOM. This study found that hyperandrogenism was present in 26.6% of nulliparous Korean women with PCOM. The present findings support the use of serum AMH as a useful marker to reflect PCOM in cases where accurate ultrasounds are not available. Conclusions: This study found that PCOM did not equate with PCOS, although PCOM is one of the diagnostic criteria for PCOS. AMH levels were positively correlated with ovarian volume and AMH levels were not reflected by hyperandrogenism. Content: The use of serum AMH as a useful marker to reflect PCOM in cases where accurate ultrasounds are not available.

Objective: To study the value of current definitions for follicle number per ovary and ovarian volume in the diagnosis of polycystic ovary syndrome (PCOS)., Design: Cross-sectional study., Setting: University tertiary care center., Patient(s): Women diagnosed with PCOS after standardized screening were eligible for inclusion in the PCOS group. Women without PCOS who underwent the same screening, had regular menstrual cycles, normal hormonal values, and no other endocrine pathology were eligible for inclusion., Intervention(s): Not applicable., Main Outcome Measure(s): Follicle number per ovary and ovarian volume in women with PCOS, stratified by age. Linear regression models to investigate the influence of body mass index (BMI) on follicle number per ovary and ovarian volume. Differences in follicle number per ovary and ovarian volume between the PCOS phenotypes and the additional value of ovarian volume compared with follicle number per ovary., Result(s): A total of 2,492 women (16-50 years) with PCOS and 152 women without PCOS were included. Most women with PCOS up to age of 35 exhibit a follicle number per ovary ≥20 (87.8%-100%) (using an ultrasound transducer ≥8 MHz) or ≥12 (95.1%-98.6%) (using a transducer <8 MHz), followed by a decline in follicle number per ovary >35 years. Median ovarian volume was below the 10 mL cutoff in every age group, for both ultrasound transducers. Follicle number per ovary and ovarian volume were higher in women with PCOS compared with women without PCOS in every age category. In our cohort, 13/2,297 women with PCOS (0.6%) would not have received the diagnosis if ovarian volume was not considered a marker for polycystic ovarian morphology. For both ultrasound transducers, women with phenotype A (ovulatory dysfunction + hyperandrogenism + polycystic ovarian morphology) exhibited the highest follicle number per ovary and ovarian volume, followed by phenotype D (ovulatory dysfunction + polycystic ovarian morphology), then phenotype C (hyperandrogenism + polycystic ovarian morphology), and then phenotype B (ovulatory dysfunction + hyperandrogenism). No clinically significant correlation between BMI and follicle number per ovary or ovarian volume was observed., Conclusion(s): Criteria to define follicle number per ovary should be established per age category, as follicle number per ovary decreases with age. Ovarian volume shows a less clear decline with age and has a lower discriminative power, and therefore could be excluded from the diagnostic criteria. Follicle number per ovary does not need to be stratified by BMI., Competing Interests: Declaration of Interests K.v.d.H. has nothing to disclose. F.B. has nothing to disclose. E.v.S. has nothing to disclose. M.E.L. has nothing to disclose. J.S.E.L. reports grants from Ansh Labs, Ferring, Roche Diagnostics, Merck, outside the submitted work; personal fees from Ferring, Titus Healthcare, Gedeon Richter, Ansh Labs, Roche Diagnostics; honoraria and travel expenses from Ferring and Roche Diagnostics; data safety monitoring board for LOCI Trail UK; an unpaid Board Member and President of the Androgen Excess and PCOS Society; and a member of the American Society for Reproductive Medicine Research Integrity Committee, outside the submitted work. Y.V.L. reports honoraria fees from Ferring and Merck; travel support from Ferring; and funding from Synergy Erasmus Medical Center grant, outside the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Question: Does unilateral oophorectomy modify the relationship between serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC)?Summary Answer: No altered 'per-ovary' and 'per-follicle' AMH production and antral follicle distribution was evident in unilaterally oophorectomized women compared to matched controls.What Is Known Already: The age of menopause onset is relatively unchanged in patients having undergone unilateral oophorectomy. Mechanisms that occur to preserve and maintain ovarian function in this context remain to be elucidated.Study Design, Size, Duration: Forty-one infertile women, with no polycystic ovary syndrome (PCOS) and no endometriosis, aged 19-42 years old, having undergone unilateral oophorectomy (One Ovary group; average time since surgery: 23.8 ± 2.2 months) were retrospectively age-matched (±1 year) with 205 infertile women having two intact ovaries and similar clinical features (Control group).Participants/materials, Setting, Methods: Serum AMH levels, 3-4 mm AFC, 5-12 mm AFC, and total AFC (3-12 mm) were assessed on cycle Day 3 in both groups. Hormonal and ultrasonographic measurements obtained from patients in the Control group (i.e. having two ovaries) were divided by two to be compared with measurements obtained from patients of the One Ovary group (i.e. having one single remaining ovary). To estimate per-follicle AMH production, we calculated the ratio between serum AMH levels over 3-4 mm AFC, 5-12 mm AFC, and total AFC (3-12 mm), and the strength of the correlation between serum AMH levels and total AFC. The main outcome measure was to assess Day 3 AMH/Day 3 AFC ratio and hormonal-follicular correlation.Main Results and the Role Of Chance: As expected, before correction, mean serum AMH levels (1.46 ± 0.2 vs 2.77 ± 0.1 ng/ml, P < 0.001) and total AFC (7.3 ± 0.6 vs 15.1 ± 0.4 follicles, P < 0.0001) were lower in the One Ovary group compared to the Control group, respectively. Yet, after correction, per-ovary AMH levels (1.46 ± 0.2 vs 1.39 ± 0.1 ng/ml) and total AFC (7.3 ± 0.6 vs 7.5 ± 0.2 follicles) values were comparable between the two groups. Consistently, per-follicle AMH levels (3-4 mm, 5-12 mm, and total) were not significantly different between the two groups (0.39 ± 0.05 vs 0.37 ± 0.02 ng/ml/follicle; 0.69 ± 0.12 vs 0.59 ± 0.05 ng/ml/follicle, and 0.23 ± 0.03 vs 0.19 ± 0.01 ng/ml/follicle; respectively). In addition, the prevalence of 3-4 mm follicles was comparable between the two groups (66.7% for One Ovary group vs 58.8% for Control group, respectively). Finally, the correlation between serum AMH levels and total AFC was similar for patients in the One Ovary group (r = 0.70; P < 0.0001) compared to those in the Control group (r = 0.68; P < 0.0001).Limitations/reasons For Caution: The retrospective character of the analysis might lead to potential bias.Wider Implications Of the Findings: The present investigation did not provide evidence of altered 'per-ovary' and 'per-follicle' AMH production and antral follicle distribution in unilaterally oophorectomized women compared to matched controls. Further studies are warranted to support the hypothesis that follicle-sparing mechanisms are clearly at stake in remaining ovaries after unilateral oophorectomy to explain their long-lasting function and timely menopausal onset.Study Funding/competing Interest(s): The authors have no funding or competing interests to declare.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background/Aim: Primary ovarian insufficiency (POI) is defined as the depletion of the primordial follicle pool in women under the age of 40. New methods for stimulating ovarian follicle cells are being investigated in order to ensure the continuity of the menstrual cycle and fertility. The present study aimed to compare follicle reserves after ovarian striation or ovarian fragmentation in rats with ovarian insufficiency. Methods: Thirty adult female rats in the estrus phase were randomized into three groups. Group 1 and Group 2 were medicated with intraperitoneal 7.5 mg/kg paclitaxel to create ovarian insufficiency. Group 3 was the control group, and intraperitoneal 3 mL 0.9% sterile saline solution was administered. The first laparotomy was performed to evaluate ovarian insufficiency 1 week after chemotherapy. In Group 1, the right ovarian cortex was striated using an insulin injector. In Group 2, the right ovary was divided into five parts. These five pieces were transferred to the pocket created under the right pelvic peritoneum. In Group 3, only laparotomy was performed. After 1 month, all rats underwent a second laparotomy, and the number of ovarian follicles (primordial, primary, secondary, antral) were compared, as were their serum follicle-stimulating hormone (FSH) and estradiol (E2) levels. Results: There was a significant difference in the number of follicles among all three groups (P<0.05). The number of follicles (primordial, primary, secondary, antral) was significantly higher in the striated group than in the fragmented group (P<0.001). There were no statistically significant differences between the three groups in terms of mean serum FSH and E2 values measured at the second laparotomy (P>0.05). Conclusion: Ovarian striation on the ovary cortex may be a new method for the treatment of ovarian insufficiency. [ABSTRACT FROM AUTHOR]

The total body irradiation of lymphomas and co-irradiation in the treatment of adjacent solid tumors can lead to a reduced ovarian function, premature ovarian insufficiency, and menopause. A small number of studies has assessed the radiation-induced damage of primordial follicles in animal models and humans. Studies are emerging that evaluate radiation-induced damage to the surrounding ovarian tissue including stromal and immune cells. We reviewed basic laboratory work to assess the current state of knowledge and to establish an experimental setting for further studies in animals and humans. The experimental approaches were mostly performed using mouse models. Most studies relied on single doses as high as 1 Gy, which is considered to cause severe damage to the ovary. Changes in the ovarian reserve were related to the primordial follicle count, providing reproducible evidence that radiation with 1 Gy leads to a significant depletion. Radiation with 0.1 Gy mostly did not show an effect on the primordial follicles. Fewer data exist on the effects of radiation on the ovarian microenvironment including theca-interstitial, immune, endothelial, and smooth muscle cells. We concluded that a mouse model would provide the most reliable model to study the effects of low-dose radiation. Furthermore, both immunohistochemistry and fluorescence-activated cell sorting (FACS) analyses were valuable to analyze not only the germ cells but also the ovarian microenvironment.

Objective: To explore factors causing a premature rise in luteinizing hormone among high ovarian responders undergoing the gonadotropin-releasing hormone (GnRH) antagonist ovarian stimulation protocol.Methods: The present retrospective study included healthy women undergoing fresh cycles using a fixed GnRH antagonist protocol with a predicted high response and antral follicle count (AFC) of at least 15 at the Reproductive Medicine Center of Tongji Hospital, China, between January 1 and December 31, 2016. Treatment-related characteristics, hormone changes, and pregnancy outcomes were compared between patients who did or did not experience a premature luteinizing hormone rise.Results: There were 314 patients included; 49 experienced premature luteinizing hormone increases. Among patients who experienced a premature rise in luteinizing hormone, a lower two pronuclear embryo rate (P=0.038); fewer high-quality embryos (P=0.020); higher serum luteinizing hormone (P=0.006), progesterone (P=0.013), and estradiol (E2) levels (P=0.003) on the day of human chorionic gonadotropin administration; a lower clinical pregnancy rate (P=0.031); and a higher cancellation rate (P=0.006) were observed. AFC of at least 22 (P=0.001) and E2 of 669 pg/mL or higher at the start of GnRH antagonist administration were predictive of early (P=0.036) and late (P=0.033) premature luteinizing hormone increases.Conclusion: Earlier administration of GnRH antagonist could avoid premature luteinizing hormone increases among high ovarian responders, especially those with a starting AFC of 22 or more. [ABSTRACT FROM AUTHOR]

Various ovarian reserve tests were developed to estimate the ovarian reserve and predict about the outcome in subfertile females undergoing evaluation for assisted reproduction. FSH and AMH levels are considered to be good ovarian reserve indicators along with antral follicle count. Objectives: To explore relationship of AMH and FSH in patients undergoing IVF with respect to ovarian reserve and outcome of the treatment. Study Design: Prospective cohort. Study Period: 1st January 2015 to 31st December 2015. Place of study: Lahore Institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore Material and Methods: In 346 IVF/ICSI patients after anthropometric measurements and transvaginal ultrasound antral follicle count were assessed in each ovary. For the hormone measurements blood samples were taken during the early follicular phase of menstrual cycle. Clinical pregnancy was also visualized through transvaginal ultrasound. Results: From the 346 IVF/ICSI patients 89 (25.79%) clinical pregnancies resulted. The mean age in pregnant group was 32.89 ± 2.99 years and in non-pregnant group was 33.62 ±4.36. Mean FSH and AMH in pregnant group was 6.38 ±2.38, 3.27 ±1.86 and in non- pregnant group was 7.54±3.76, 2.72 ± 1.82 respectively. Age and FSH are significantly associated with each other (p-vale = 0.000) and mostly patients had FSH below 9(mIU/mL). Age and AMH are significantly associated with each other (p-vale = 0.000) and mostly patients had AMH above 1.5 (ng/mL). Conclusions: Better pregnancy rate was associated with FSH below than 9 (mIU/mL) and AMH above 1.5 (ng/mL). [ABSTRACT FROM AUTHOR]

Background: To measure the effect of age on ovarian and uterine morphology in infertile women with polycystic ovaries (PCO) Methods: In this observational cross sectional study 100 primary infertile women with PCOs (confirmed by ultrasonography) were subdivided into two age groups. Group-I included between age groups 20-30 years and Group II ranged from 31- 40 years. The ovarian volume (OV), follicles count (FC) and size (FS), uterine area (UA) and endometrial thickness (Endo) were determined by ultrasonography. Results: The ovarian morphology showed a significant decrease in group II; the OV transabdominally was 14.26± 2.42 vs 10.56±1.0 (0.001) and transvaginally 14.93±2.55 vs 11.75±1.06 (0.001). The FC was 14.00±1.60 vs 12.3±0.78 (0.023) and FS was 8.23±8.9vs 3.29±6.9 (0.001). The uterine morphology however showed a significant increase in group II. The UA was 88.79±5.83 vs 119.71±22.83 (0.001) and endo was 0.56±0.10 vs 0.67±0.12 (0.001) Conclusion: The ovarian morphology variables which include OV, FC and FS decreases in the older infertile group of women with PCOs but the uterine morphology variables showed an increase in area with thickening of endometrium in the older group.

Purpose: AMH is used to quantify the extent of follicular pool in postpubertal women, but its value after chemotherapy is unclear. We tested AMH as a marker of follicular reserve in adult mice treated with cyclophosphamide (CTX) in prepubertal age. Methods: Mice received placebo or CTX at age 18 days. AMH and FSH were assessed on day 43, 56, and 95 of life. Ovaries were fixed in formalin, embedded in paraffin, and stained with H&E and TUNEL. Follicular apoptosis was graded. Results: All mice exposed to CTX had a decreased number of follicles/mm 2 and significantly decreased AMH, but only 48 % of pubertal and 81 % of adult mice had increased FSH. Over time, there was an increase in FSH ( p < 0.05), but not a concurrent decrease in AMH, while in controls, FSH remained stable and AMH decreased. There was no correlation between histological and serological markers. Conclusions: CTX administration to pre-pubertal mice caused various degrees of residual function, which were reflected by FSH, but not by AMH or by the number of ovarian follicles. AMH served as a marker of quantitative, and FSH of qualitative, residual ovarian function. [ABSTRACT FROM AUTHOR]

Objective: To compare the morphology of pelvic reproductive organs between fertile and infertile women with polycystic ovaries. Methodology: This cross sectional comparative study was performed at Rahat Hospital, Karsaz Karachi from January 2008 to December 2008. In which 100 women diagnosed with polycystic ovaries identified by ultrasound were inducted for the study; 50 were fertile and 50 were infertile (20-40 years). Transabdominal scan (TAS) was performed to rule out abnormalities other than PCO. Ovarian volume (OV) in cm3, follicle count (FC) and size (FS) in mm, uterine area (UA) in cm², endometrial thickness (Endo) in mm were measured and noted by transvaginal scanning (TVS) ; Basal Metabolic Rate (BMI) was calculated and correlated with endometrial thickness. Unpaired t-test and Pearson correlation were used for analysis. Result: In the total fertile and infertile women with PCO the following result was obtained OV-TAS 7.33 ±3.17 vs. 10.87±2.49(0.001), OV-TVS 8.79±2.19 vs. 12.44±2.36(0.001), FC 14.41±2.18 vs. 14.75±2.80 (0.245), FS 3.26±0.22 vs. 8.99±0.45 (0.001), BMI 25.6±4.7vs. 27.6±5.7(0.04), UA 86.9±25.7 vs. 117.2±29.0(0.001) and Endo 4.5±1.4 vs 5.8±1.9(0.052). BMI and endometrial thickness showed a positive correlation with 'r' value of 0.06(0.05) in the infertile women and a negative correlation with 'r' value of - 0.40(0.05) in fertile women. Conclusion: The OV, FS, BMI, UA and Endo show a significant increase in the infertile women who are suffering from PCO. However the FC showed no significant difference between the two groups. The BMI and endometrial thickness has shown a positive correlation with infertility. [ABSTRACT FROM AUTHOR]

Introduction: Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted reproduction. The cutoff values of AMH for prediction of poor response have not yet been determined. Material and methods: Ninety women undergoing their first IVF/ICSI cycle were prospectively included in this clinical, non-interventional study. Baseline AMH, follicle stimulating hormone (FSH) and antral follicle count (AFC) were measured before starting ovarian stimulation. AMH was also measured on day 5 of stimulation and in the follicular fluid of the first aspirated follicle. The predictive value of baseline AMH, day 5 AMH and follicular fluid AMH were assessed comparatively to FSH and AFC for ovarian response. Ovarian response was defined as poor (<4 oocytes), high (>12 oocytes) or normal (≥4 oocytes and ≤12 oocytes). However, only 3 patients met the criterion for high ovarian response and thus analysis was focused on the prediction of poor response. Results: Significant differences were present between poor responders and non-poor responders regarding FSH ( p == 0.019), baseline AMH ( p == 0.002), AFC ( p < 0.001), day 5 AMH ( p == 0.005) but not for follicular AMH ( p == 0.183). The largest AUC (area under the curve) for poor ovarian response was obtained by AFC (AUC == 0.81) followed by baseline AMH (AUC == 0.70). At a level below 2.74 ng/mL, the sensitivity of the test is 69% and specificity is 70.5%. Conclusion: Baseline AMH is almost as good a predictor for poor ovarian response as AFC. [ABSTRACT FROM AUTHOR]

Objective: To verify whether the presence of an overdeveloped antral follicle modifies the expected relationship between serum antimüllerian hormone (AMH), estradiol, or follicle-stimulating hormone (FSH) levels and antral follicle count on cycle day 3. Design: Prospective study. Setting: Teaching hospital, France. Patient(s): Two hundred seventy-seven normo-ovulating women. Intervention(s): Serum AMH, estradiol, and FSH levels and the number and size of antral follicles (3 to 12 mm) were measured on cycle day 3. Two groups were set according to the presence ("large" group) or absence ("small" group) of at least one follicle measuring >7 mm. Main Outcome Measure(s): Hormonal-follicular correlation. Result(s): Whereas, as expected, the correlation between FSH and follicle counts was affected by the presence of an overdeveloped follicle, the correlation between AMH and follicle counts remained unaffected. Estradiol failed to be correlated with antral follicle counts in both groups. Conclusion(s): In contrast with FSH, AMH levels remain tightly correlated to the number of antral follicles despite the presence of early growing follicles on cycle day 3. [ABSTRACT FROM AUTHOR]

Abstract: Poor reliability has been reported when counting the total number of follicles in polycystic ovaries using conventional two-dimensional (2-D) ultrasound viewing methods. In the current study, we report good reliability in follicle counts when observers imposed a programmable grid system over the viewing window. Four observers estimated total follicle counts in 45 ovarian ultrasound scans by compartmentalizing the ovary into 9 to 12 grid sections and performing focused follicle counts per section. The mean number of follicles counted per ovary was 44.6 ± 2.3. The level of inter-observer agreement when making follicle counts was 0.82 and total follicle counts did not differ among observers. The level of intra-observer agreement was 0.93 which further corroborated the utility of this method for making dependable follicle counts. In summary, the ability to obtain reproducible follicle counts will help to establish reliable diagnostic criteria for polycystic ovarian morphology. (E-mail: MEL245@cornell.edu) [Copyright &y& Elsevier]

Objective: To verify whether, during the luteal-follicular transition, increased inhibin B production by abnormally large follicles modifies the expected relationship between the number of follicles and peripheral inhibin B and FSH levels. Design: Prospective study. Setting: Teaching hospital, France. Patient(s): A total of 192 normo-ovulatory women. Intervention(s): Serum inhibin B and FSH levels and numbers and sizes of antral follicles (3-12 mm) were measured on cycle day 3. Main Outcome Measure(s): The strength of hormonal-follicular correlations was assessed in two groups formed according to the presence (large follicle group; n = 73) or absence (small follicle group; n = 119) of one follicle measuring >7 mm. Result(s): Serum inhibin B and FSH levels were correlated with antral follicle counts (r = 0.32 and r = -0.44, respectively). These relationships were significantly weaker in the large follicle group (r = 0.24 and r = -0.28, respectively) than in the small follicle group (r = 0.51 and r = -0.55, respectively). Conclusion(s): Antral follicle size influences serum inhibin B and FSH levels and alters their expected relationship with the number of antral follicles on day 3. These results contribute to clarifying the controversial role of serum inhibin B and FSH levels in the prediction of ovarian follicular status. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy of ovarian volume, antral follicle count and age in predicting menopausal status in healthy women.Methods: The cross-sectional study was set in the Gynecology Division at the Leonor Mendes de Barros Maternity Hospital, São Paulo, Brazil. The subjects of this study were premenopausal (n = 121) and postmenopausal (n = 71) healthy women aged between 40 and 55 years. They were submitted to a medical interview and transvaginal ultrasound examination. The ovarian volume (cm3), antral follicle count and chronological age were recorded in both groups and the accuracies of these parameters in predicting menopausal status were compared.Results: Premenopausal women presented larger ovaries than postmenopausal women (p < 0.01). Premenopausal women had a higher number of antral follicles than postmenopausal women (p < 0.01). The receiver operating characteristic curves showed that ovarian volume, age and antral follicle count had similar sensitivities and specificities in predicting menopausal status. The best cut-off points were observed when ovarian volume was <4 cm3, age was > or =48 years and antral follicle count was < or = two follicles.Conclusions: Ovarian volume, antral follicle count and chronological age are all individually predictive of menopausal status, with similar accuracies. [ABSTRACT FROM AUTHOR]

The total body irradiation of lymphomas and co-irradiation in the treatment of adjacent solid tumors can lead to a reduced ovarian function, premature ovarian insufficiency, and menopause. A small number of studies has assessed the radiation-induced damage of primordial follicles in animal models and humans. Studies are emerging that evaluate radiation-induced damage to the surrounding ovarian tissue including stromal and immune cells. We reviewed basic laboratory work to assess the current state of knowledge and to establish an experimental setting for further studies in animals and humans. The experimental approaches were mostly performed using mouse models. Most studies relied on single doses as high as 1 Gy, which is considered to cause severe damage to the ovary. Changes in the ovarian reserve were related to the primordial follicle count, providing reproducible evidence that radiation with 1 Gy leads to a significant depletion. Radiation with 0.1 Gy mostly did not show an effect on the primordial follicles. Fewer data exist on the effects of radiation on the ovarian microenvironment including theca-interstitial, immune, endothelial, and smooth muscle cells. We concluded that a mouse model would provide the most reliable model to study the effects of low-dose radiation. Furthermore, both immunohistochemistry and fluorescence-activated cell sorting (FACS) analyses were valuable to analyze not only the germ cells but also the ovarian microenvironment.

Introduction: The anti-Müllerian hormone (AMH) plays an inhibitory role during folliculogenesis by regulating the number of follicles entering the growing pool. Antral follicle counts (AFC) are highly correlated with serum AMH concentrations and both appear to be related to the ovarian reserve in several species. Few data on AMH and AFC in mares exist, especially with regard to fertility. Therefore, the objective of the current study was to investigate the interrelationship between antral follicle count, serum AMH concentrations and fertility outcome in mares. One hundred and twenty-seven mares were enrolled in the study and grouped according to their reproductive status. Around time of estrus, serum AMH concentrations and AFC before and after ovulation were determined. Mares were artificially inseminated and pregnancy diagnosis was performed 14 to 18 days later. A high inter-individual variability in AFC and AMH concentration and a positive relationship between AMH and AFC for follicles ≤ 30 mm in diameter were observed, with a stronger correlation in mares older than 18 years. A high correlation between AFC measurements before and after ovulation was identified. The AFC after ovulation was higher than AFC before ovulation. AMH concentrations were neither related to the mares' reproductive status nor to age, number of cycles needed for pregnancy and pregnancy outcome. Excepted for a higher AFC in the middle-aged mares (9-18 years) compared to the younger mares (< 9 years), no associations between AFC and age, reproductive status as well as fertility of mares were found. This study confirms the relationship between AFC and AMH and a high degree of reproducibility of AFC measurements. However, based on our findings, neither AFC nor AMH are useful predictors of fertility in mares.

The ovary is a complex endocrine organ that shows significant structural and functional changes in the female reproductive system over recurrent cycles. There are different types of follicles in the ovarian tissue. The reproductive potential of each individual depends on the numbers of these follicles. However, genetic mutations, toxins, and some specific drugs have an effect on follicles. To determine these effects, it is of great importance to count the follicles. The number of follicles in the ovary is usually counted manually by experts, which is a tedious, time-consuming and intense process. In some cases, the experts count the follicles in a subjective way due to their knowledge. In this study, for the first time, a method has been proposed for automatically counting the follicles of ovarian tissue. Our method primarily involves filter-based segmentation applied to whole slide histological images, based on a convolutional neural network (CNN). A new method is also proposed to eliminate the noise that occurs after the segmentation process and to determine the boundaries of the follicles. Finally, the follicles whose boundaries are determined are classified. To evaluate its performance, the results of the proposed method were compared with those obtained by two different experts and the results of the Faster R-CNN model. The number of follicles obtained by the proposed method was very close to the number of follicles counted by the experts. It was also found that the proposed method was much more successful than the Faster R-CNN model., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Magnetic resonance imaging (MRI) is suggested to be useful for counting follicles and confirming ovulation in microminipigs. However, its accuracy is unknown. We have compared the number of follicles counted by MRI to that of corpus hemorrhagicum confirmed directly by visual inspection. The follicles of 17 microminipigs were counted by using ovarian MRI on a 0.4 Tesla MRI System every 24 hr after estrus until follicle images disappeared. Then, we performed laparotomy to count their corpus hemorrhagicum. Significant correlation was observed between follicle counts obtained using MRI (5.18 ± 1.78 per head) and the numbers of corpus hemorrhagicum (5.47 ± 1.74 per head). In conclusion, follicle counts using 0.4-T MRI were reliable, and confirmed microminipig ovulation.